Drug formulary (covered drugs)


Use this formulary if you have a Kaiser Permanente Medicare health plan.

Medicare Part D formulary

The Pharmacy and Therapeutics Committee, a group of Kaiser Permanente doctors and pharmacists, chooses which drugs to include in our formulary. To make sure you always have the most effective, safe, and affordable drug options, the committee regularly reviews information about new and existing drugs. The formulary is updated monthly based on new information or when new drugs become available.

We’ll consider requests, at any time, from Kaiser Permanente members and affiliated health care providers to add or remove medications on our formulary. You can download a form (PDF) to submit a request.

Drugs that aren’t listed on the formulary, known as nonformulary drugs, aren’t covered by your plan. If your doctor decides that a nonformulary drug is medically necessary for your care, your doctor can request an exception for that drug. With an exception, the drug will be covered under your prescription drug benefit — if your plan one. Without an exception, you’ll be charged the full retail price for that drug.

The most effective way to get an exception to the formulary is to send a secure email to your doctor

You can also contact Member Services by submitting an online form. Or you can call us, Monday through Friday, 7 a.m. to 7 p.m., at:

404-261-2590
1-800-865-5811
711
(TTY)

If you want a nonformulary drug that your doctor doesn’t believe is medically necessary, you can file a grievance (Senior Advantage and Medicare Cost members can file an appeal) with Member Services at the phone numbers above.

For more information about the drugs covered by your plan, please contact Member Services, Monday through Friday, 7 a.m. to 7 p.m., at:

404-261-2590
1-888-865-5813
711
(TTY)

 

Reviewed by: Neelam Patel, Pharm. D, May 2014

NCQA content reviewed by: Tammy McDonald, NCQA Lead, January 30, 2014

This page was last updated: October 8, 2018, at 12:30 p.m. PT